Your SlideShare is downloading. ×
0
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Care Closer to Home Powerpoint.ppt
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Care Closer to Home Powerpoint.ppt

436

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
436
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
3
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • <number>
    So, what are we doing this?
    In developing the evidence around the white paper, we found in other countries, much more healthcare was provided in primary and community settings.
    Using advances in technology which has meant that kit is more portable, mobile, easier to operate and less expensive.
    People don’t really like going to hospitals and would prefer to be treated in their general practice or community setting.
  • <number>
  • <number>
  • Transcript

    • 1.   Implementing care closer to home – Convenient quality care for patients 25 May 2007 Botanical Gardens Birmingham Updated guidance on PwSI services including new robust governance arrangements for GPs and Pharmacists with Special Interests. 
    • 2.   Implementing care closer to home – Convenient quality care for patients Introduction Mark Cooke   Chief Executive Dudley PCT
    • 3.   Implementing care closer to home – Convenient quality care for patients Agenda 13:00 Introduction 13:10 Implementing Our Health Our Care Our Say Dr David Colin-Thomé, National Clinical Director for Primary Care,  LTC ,18 weeks & co-lead  for urgent care, Department of Health 13:25 The accreditation of GPs and Pharmacists with Special Interests Dr Matt Walsh, Executive Director of Commissioning and Medical Director, Leeds PCT 14:00 Market Place (and tea & coffee) 14:30 GPs with Special Interests – Dermatology & Skin Surgery Dr Julia Schofield, Consultant Dermatologist, West Hertfordshire Hospitals NHS Trust 14:40 Question and answer session 15:40 Chair’s summary 15:45 Close of workshop
    • 4.   Implementing care closer to home – Convenient quality care for patients Implementing Our Health Our Care Our Say Dr David Colin-Thomé National Clinical Director for Primary Care, LTC ,18 weeks and  co-lead for urgent care Department of Health
    • 5.   Implementing care closer to home – Convenient quality care for patients Our health, our care, our say – a new direction for community services  Ambition  Enabling health, independence and well  being  Better access to GP  Better access to community services  Support for people with longer term needs  Care close to home  Ensuring reforms put people in control  Making sure change happens
    • 6.   Implementing care closer to home – Convenient quality care for patients More health care in the community Increasing % of healthcare provided locally  reflecting:  international best practice  advances in technology  public preference  ageing population  Wanless review
    • 7.   Implementing care closer to home – Convenient quality care for patients Keeping it Personal  Build on the best of traditional General Practice  Primary Health Care more than general practice  …but registered population and 80% of all NHS  clinical consultations  90% of care solely undertaken in primary care  Support for self care  Care Closer to Home  The practice can link the wider public’s health  and bio-clinical care
    • 8.   Implementing care closer to home – Convenient quality care for patients Infrastructure Health and social system environment Decision support tools and clinical information system (NPfIT) Community Resources Delivery System Disease Management Case Management Better outcomes Prepared and proactive health and social care teams Empowered and informed patients Supported Self care Promoting Better Health Supporting Creating The NHS & Social Care - Long Term Conditions Model
    • 9.   Implementing care closer to home – Convenient quality care for patients  36 pathways, covering common conditions, that have  been developed and published in collaboration with  the Royal Colleges  Help commissioners transform pathways by removing  unnecessary stages in the patient journey and  focussing on real quality improvements  Available on the 18 weeks website www.18weeks.nhs.uk   Use of these and other pathways will greatly assist in  reducing waits To improve clinical care - 18 weeks
    • 10.   Implementing care closer to home – Convenient quality care for patients Other White Paper initiatives  Care Closer to Home Demonstration Project  – 30 across England – Range of different models (nurse led, consultant  outreach, GPwSIs)  – An evidence base for shifting care and lessons based  on experience  Community Hospitals – £750m capital funding available over 5 years  – 14 schemes announced so far (c£100m) – With more to come and not just community hospitals –  community services eg primary care centres, mobile  diagnostics, one stop health and social care centres
    • 11.   Implementing care closer to home – Convenient quality care for patients  DH worked with RCGP and developed broad  strategic advice for PCTs and GPs, and also a  series of detailed clinical guidelines for individual  specialites  NatPaCT published practical advice  PCTs now report over 1750 GPwSIs   Frameworks developed for nurses, AHPs,  Pharmacists and Community Dentists Practitioners with Special Interests (PwSIs)
    • 12.   Implementing care closer to home – Convenient quality care for patients Concerns over quality:  some developed in isolation  without appropriate training, CPD and governance  arrangements …especially from secondary care AOD found:   64% not within national guidelines  45% not been through any accreditation process  14% no experience of working in secondary care  75% did not attend clinical governance meetings However…
    • 13.   Implementing care closer to home – Convenient quality care for patients PWSI Principles  First and foremost a generalist   Must be able to act without direct supervision   The level of skill or competence will always exceed  the core competencies of the individual’s normal  professional role   A qualification alone will never demonstrate  suitability for the role   Accredited PwSIs deliver clinical services directly  to patients and it is the personal interaction and  clinical relationship between a PwSI and a patient,  which makes accreditation necessary 
    • 14.   Implementing care closer to home – Convenient quality care for patients Who can provide care closer to home? Generalist care provided in community settings Specialist care provided in community settings Specialist care provided in acute settings Accredited PwSIs: GPwSI PhwSI DwSI Accredited PwSIs: GPwSI PhwSI DwSI NHS staff providing specialist care: Nurses, AHPs, medical/consultant staff, pharmacists, healthcare scientists NHS staff providing specialist care: Nurses, AHPs, medical/consultant staff, pharmacists, healthcare scientists
    • 15.   Implementing care closer to home – Convenient quality care for patients Clinical engagement and leadership  First contact primary care - ‘Keeping it Personal’  Practice based commissioning  Generalist and specialists need to work together  Consultants have pivotal role in accreditation  Secondary care clinicians key role in shaping  redesigned services  High levels of oppositional behaviour imply that  confrontation and criticism are valued more than  creativity and risk taking
    • 16.   Implementing care closer to home – Convenient quality care for patients The accreditation of GPs and Pharmacists with Special Interests Dr Matt Walsh Executive Director of Commissioning and Medical Director Leeds PCT
    • 17.   Implementing care closer to home – Convenient quality care for patients Introduction • Credentials  GP trainer  Director of Commissioning, Clinical Governance  lead and Medical Director  Developed Bradford GPwSI accreditation process  Chair of Bradford & Airedale accreditation panel.
    • 18.   Implementing care closer to home – Convenient quality care for patients The Commissioning Cycle
    • 19.   Implementing care closer to home – Convenient quality care for patients Assess needs Assess needs Review current service provision Review current service provision Decide priorities Decide priorities Design service Design service Shape structure of supply Shape structure of supply Manage demand and ensure appropriate access to care Manage demand and ensure appropriate access to care Clinical decision making Clinical decision making Managing performance (quality, performance, outcomes) Managing performance (quality, performance, outcomes) Patient and public feedback Patient and public feedback Strategic planning Service redesign Managing demand Managing performance
    • 20.   Implementing care closer to home – Convenient quality care for patients Background & Reflections Policy Context  Emerging focus upon shifting care (GP fund- holding, HSC 1996/35, NHS Plan targets,  OHOCOS)  Emerging focus upon clinical quality & risk  Choice & plurality, PBC & PBR Impact  Variable geographical uptake and distribution of  PwSI initiatives  Focus upon reducing outpatient attendances • Opinion–based specialties  Technical interventions • Endoscopies, cystoscopies • ECG, 24hr BP, anticoagulation
    • 21.   Implementing care closer to home – Convenient quality care for patients Emerging Concerns Specific  Definition  Clinical risks  Accreditation  Qualification  Standards & Quality  Service vs Individual General  Local service and pathway coherence in a competitive environment • PBR and competition on quality • VFM and effectiveness  Supporting patients • Local services • Assumptions about quality • Choice as it relates to PwSIs
    • 22.   Implementing care closer to home – Convenient quality care for patients What’s this all about?  CPLNHS and proper commissioning – Improving access  – Improving quality – Addressing health inequalities – Provider development  Clarifying definitions and rationale  Supporting innovation  Managing risk & protecting patients
    • 23.   Implementing care closer to home – Convenient quality care for patients Vision  What does good clinical governance look like for  PwSI services?  Minimum necessary bureaucracy  Not duplicating other regulatory processes  Clear responsibilities for:  – PwSI – Commissioners – Providers – Accreditation bodies
    • 24.   Implementing care closer to home – Convenient quality care for patients Emerging themes  Gate-keeping function of primary care  Blurring boundaries between clinicians  Focus upon assessment of competencies  required vs those demonstrated  Coherent service planning and development  Guarding the notion of specialism.   Refreshed specialty specific guidance
    • 25.   Implementing care closer to home – Convenient quality care for patients Key points  Core generalist role  Receive and manage referrals – Referral as the trigger point   Higher levels of skill – Specialty specific guidance  Independent – ie no direct supervision
    • 26.   Implementing care closer to home – Convenient quality care for patients New PwSI definition “A GP or a Pharmacist with a Special Interest supplements their core generalist role by delivering an additional high quality service to meet the needs of patients. Working principally in the community, they deliver a clinical service beyond the scope of their core professional role or may undertake advanced interventions not normally undertaken by their peers. They will have demonstrated appropriate skills and competencies to deliver those services without direct supervision. “
    • 27.   Implementing care closer to home – Convenient quality care for patients The Accreditors  Subset of PCT and include, as a minimum:  Senior commissioner  Senior professional rep (LMC, PEC, LPC, Lead Pharmacist, GP from RCGP)  Lay person  Senior clinician  Adhere to set of competencies (Page 9)
    • 28.   Implementing care closer to home – Convenient quality care for patients Overview Page 8
    • 29.   Implementing care closer to home – Convenient quality care for patients Commissioners preliminary rolePage 10 Develop service specification by defining:  Patient inclusion criteria  Referral arrangements to and from all other services  How they communicate and integrate with relevant clinical networks  Physical, human, audit and financial resources required to deliver the service  Robust and integrated clinical governance arrangements  Support required from other health and social care professional and services  Evidence of the ways in which local people have been involved in developing and planning the service  A clear definition of the role that the individual GPwSI or PhwSI will play within the service  Arrangements to ensure that the GPwSI or PhwSI understands clearly the nature of all the services which support the patient pathway, clinical network, and referral system  Arrangements for the GPwSI’s or PhwSI’s ongoing continuing professional development  That appropriate indemnity cover is in place  Requirement that there is a properly authorised statement of compliance with Standards for Better Health
    • 30.   Implementing care closer to home – Convenient quality care for patients Page 11 Step 1 Invite applications from individuals who wish  to be accredited
    • 31.   Implementing care closer to home – Convenient quality care for patients Page 12 Step 2 Verify the skills and competencies of the  individual GPwSI or PhwSI and reach a decision about individual accreditation
    • 32.   Implementing care closer to home – Convenient quality care for patients Page 13 Step 3 Optional service visit to validate the quality of  the provision and the role of the individual  GPwSI or PhwSI
    • 33.   Implementing care closer to home – Convenient quality care for patients Page 14 Step 4 Re-accreditation of the individual GPwSI or  PhwSI and the service in which they work (at  least every three years)
    • 34.   Implementing care closer to home – Convenient quality care for patients Local (PCT held) list g • GPwSI/PhwSI • Length/dates of accreditation • Specialty • Available for public inspection
    • 35.   Implementing care closer to home – Convenient quality care for patients PCT Directions PCTs shall have regard to the provisions set out in Part 3 when commissioning, assessing or accrediting a GP/PhwSI service
    • 36.   Implementing care closer to home – Convenient quality care for patients Implementation timescales  All existing GPwSIs be re-accredited by March 2009  All new GPwSIs and PhwSIs be accredited in  accordance with these guidelines.  If the GPwSI or PhwSI’s work is discontinued, or if for  any other reason after the commencement of the  service the individual is unable to use their enhanced  skills for a period longer than twelve months, they  should be re-accredited before they work again as a  GPwSI or PhwSI.
    • 37.   Implementing care closer to home – Convenient quality care for patients Market Place (and tea & coffee) 14:00 – 14:30
    • 38.   Implementing care closer to home – Convenient quality care for patients GPs with Special Interests Dermatology & Skin Surgery Dr Julia Schofield Consultant Dermatologist West Hertfordshire Hospitals NHS Trust Member PwSI Steering Group and Dermatology GPwSI guidance development group
    • 39.   Implementing care closer to home – Convenient quality care for patients Dermatology GPwSIs: Background NHS Plan 2000: ‘..up to 1000 specialist GPs to take referrals from their colleagues for a range of conditions..’ Dermatology one of the specialities identified as  suited to the role of GPwSIs
    • 40.   Implementing care closer to home – Convenient quality care for patients Dermatology GPwSIs: 2003 framework
    • 41.   Implementing care closer to home – Convenient quality care for patients Dermatology GPwSIs: 2003 framework THE GOOD NEWS Action on Dermatology pilots:  Reduced waiting times for those  attending clinics  Several sessions needed across  a health community to reduce  overall access times  Quality of care and patient  experience good  Good links with secondary care  optimise seamless patient care
    • 42.   Implementing care closer to home – Convenient quality care for patients  Integrated model, works well, robust training  and accreditation programme  Big increase in capacity (10 clinics per week)  Trivial referrals received initially  Reduction in referrals to secondary care  Secondary care referrals more appropriate Threat to secondary care funding?  ‘previously unmet demand is now being met and met appropriately..’ Eastern Wakefield PCT: Lessons
    • 43.   Implementing care closer to home – Convenient quality care for patients Dermatology GPwSIs: Concerns Following audit* against DH framework BAD/PCDS/AoD meeting requested (Feb 2005):  More robust accreditation framework for  dermatology  Some standardisation of terms and  conditions  Audit, quality and outcome measures *Schofield JK, Irvine A, Jackson S, Adlard TP, Gunn S, Evans N. General Practitioners with a Special Interest (GPwSI) in Dermatology: results of an audit against Department of Health (DH) guidance. Br J Dermatol 2005; 153 (suppl. 1):0-1 
    • 44.   Implementing care closer to home – Convenient quality care for patients  Developed by  multidisciplinary  working group  including reps from  BAD, PCDS, SCC,  RCGP  Aims to ensure the  commissioning of  high quality  dermatology  services
    • 45.   Implementing care closer to home – Convenient quality care for patients Contents Contents  Service models for dermatology and skin  surgery  The support and facilities required  The curriculum and core competencies  required  Key points to consider  Assessment tools  Assessment requirements
    • 46.   Implementing care closer to home – Convenient quality care for patients Possible models of service delivery Diagnostic and disease management service only with no surgery Community skin cancer service GPwSI dermatology skin surgery service (excluding skin cancer) Diagnostic and disease management service with more advanced surgery Diagnostic and disease management with a limited skin surgery service
    • 47.   Implementing care closer to home – Convenient quality care for patients
    • 48.   Implementing care closer to home – Convenient quality care for patients Assessment tools
    • 49.   Implementing care closer to home – Convenient quality care for patients Skin surgery: GPwSIs and PwSIs  Dermatology guidance specifically for GPwSIs  BUT includes standards for all performing skin  surgery (PwSIs)  Commissioners advised to use the document  when developing skin surgery services  Competencies may be further developed for  other PwSIs (PhwSIs)
    • 50.   Implementing care closer to home – Convenient quality care for patients Specialty Specific Guidance  RCGP co-ordinating refresh through relevant  professional bodies  Evidence to support commissioners and  accreditors during accreditation process  Competency based  In most cases applicable to all PwSIs  Published throughout 2007
    • 51.   Implementing care closer to home – Convenient quality care for patients Developing Dermatology GPwSI services  Assess need, Part 2 guidance, patient centred  process involving all key players  Define model of care and identify local skills  and resources  Accredit the individual once the model of care  has been agreed  Be mindful of National Guidance (NICE skin  cancer)
    • 52.   Implementing care closer to home – Convenient quality care for patients Developing Dermatology GPwSI services  Whatever the barriers try and be joined up  Integrated services work best for patients  Think quality, access, patient experience first  Value for money last!!
    • 53.   Implementing care closer to home – Convenient quality care for patients How do we get there? DONALD RUMSFELD:  There are known knowns. There are things we know that we know. There are known unknowns. That is to say, there are things that we now know we don't know. But there are also unknown unknowns. There are things we do not know we don't know.
    • 54.   Implementing care closer to home – Convenient quality care for patients Question & Answer session 14:40 – 15:40 Panel Members Dr David Colin-Thomé Dr Matt Walsh Dr Julia Schofield
    • 55.   Implementing care closer to home – Convenient quality care for patients Close Contacts for further information Have a safe journey home.. Beth Taylor Beth.taylor@southwarkpct.nhs.uk Phil Walker Philip.walker@dh.gsi.gov.uk www.dh.gov.uk www.primarycarecontracting.nhs.uk

    ×